PSYC 3700 Exam 3

What contributed to the public fear that people with SZ are violent?

deinstitutionalization lead to a shift to outpatient community practices which caused the public to become worried about erratic behaviors.

What led to deinstitutionalization (1970s)?

The 1st antipsychotic was introduced: Chlorpromazine which caused in person psychiatric facilities to close

What were the outcomes of deinstitutionalization?

People who were discharged went to prison or became homeless.

People with newly developing illnesses: no facilities because they were all closed

What is the Myth of Violence and the fact v.s reality?

people with mental illnesses are violent and dangerous

fact: within the last few years, the U.S. has had an increase in mass violence

reality: violence is not a mental illness

What % of violent crime in the U.S. are committed by people with serious mental illnesses?

5% (very less)

Are individuals with mental illnesses more likely to be victims of violence or perpetrators?

victims of violence

What is the odds ratio of the risk of any violence in SZ?

about 1 are at risk for this behavior in SZ

general population: 0.02%

SZ: 0.03%

substance use: 0.03%

What is the implication of the same rate of violence in SZ and substance use disorders?

comorbidity (driven by substance use)

Do gun laws and general rates of violence influence the rate of violence in SZ?

NO

What is the definition of general violence?

“behavior involving physical force intended to hurt, kill, or damage.”

What is the definition of severe violence?

violence that causes significant or permanent injury.

What are types of violence to self?

psychosis is a common contributing factor

suicide (10-30%: more common in people who have never received antipsychotics), self-mutilation (harming/ damaging oneself)

During what phase of illness is violence most common and %(s) of severity?

The 1st episode (before receiving antipsychotic treatment)

any violence (during or before treatment): 33%

serious violence: 16%

severe assault: <1%

What is the risk greater in the 1st episode?

They have reduced insight into their symptoms causing them to feel distressed.

Following antipsychotic treatment is low: 50% in 1st episode, 12% among those with violent acts

What are the characteristics of those who commit serious violence?

They have never received psychotic treatment, 1st episode, substance use, and(or) male.

What should be done to decrease violence in SZ?

People should be engaged in treatment earlier (during prodermal period) and barriers to care should be reduced (community-based approach, mental health laws)

How much does receiving treatment reduce the risk of violence?

reduced by 20x

How much greater is the risk for violence during the 1st episode than any other time in the course of the illness?

before/during 1st episode: 1/600

after treatment: 1/9000

What are the applicable definitions of stigma?

“attribute that is deeply discrediting” and reduces the person who has it from a “whole person” to a “tainted,discounted” person.

“labeling, stereotyping, separation, status loss, discrimination.”

What is public stigma?

How people without the condition think about people with the condition.

What are the types of personal stigma?

perceived stigma: thoughts about how others perceive them

experienced stigma: someone with psychosis personally experienced discrimination

internalized stigma: thoughts about condition are deemed as true

How is public stigma studied?

perceived dangerousness, negative emotions, discrimination

emotional reactions

What results in more positive or negative reactions of public stigma?

Negative Reactions: biological cause (born w it), using labels (mental illness/SZ)

Positive Reactions: higher education, younger males, personal experiences, contact w some w psychiatric disorders

What is the stigma around mental health professionals?

SZ is the most stigmatized, most MHP don’t know how to help

positive beliefs: low danger risks, pharmacological treatment

negative beliefs: prognosis, social distance, biological=dehumanization

neutral beliefs: associations w age, length, profession

What is the history of public stigma interventions?

1950s: films

1999: while house mental health conference (clinton), resulted in 1st anti-stigma campaigns

What are the 3 approaches to public stigma intervention and how effective are they?

3 approaches:

1. education: challenge w facts

2. interpersonal contact with stigmatized groups: lessens prejudice

3. social activism: highlights injustice

*face to face contact produced the most impact (video call also working equally for adolescents)

What does self-stigma include psychologically?

social construct: ideas of other shape how we see ourselves, which results in shame

and continued discrimination makes them believe the stereotypes are true

How common is it to experience different types of personal stigma?

general: 65%

structural (rehabilitation): 43%

interpersonal (rejection/avoidance): 64%

public image (media): 56%

societal roles (occupation): 57%

What are the outcomes of personal stigma?

lower quality of life & self-esteem

positive symptoms & depression/anxiety

lower recovery rates

What are the strategies that can be used to decrease the negative effects of stigma in individuals?

• telling myth from fact, respond to stigma

• use cognitive-behavioral principles to change thinking

• increase sense of self worth and belonging

What are the 4 forms of racism?

personal: private/personal beliefs of prejudice

interpersonal: expression of racism between individuals

institutional: discriminatory treatment in policies/institutions

structural: norms and social systems cause racial inequality

What are the 3 social determinants of health (what determines health)?

wealth, power, & prestige

those denied these 3 have less worse health outcomes

What is the impact of health inequalities?

reduced access to healthcare: disease, poor health

increased incidence of psychopathology bc societal norms influence access to resources and exposure to stepsons (trauma, discrimination, family stress)

Who is most affected by health inequalities?

Minority culture group and lower SES (social economic status) groups

Which group(s) are commonly exposed to structural racism? What is the specific definition of structural racism?

def: stratification of power based on proximity to the majority cultural population (white)

groups: african descent

Why does structural racism have an enduring effect on health outcomes?

limits access to flexible resources including neighborhood segregation, education, and career prospects

Are there racial differences in the prevalence of SZ and what are some factors that influence the height rate of diagnosis?

Yes, higher incidence and prevalence among black people (african & caribbean heritage).

Factors: discrimination, early life stress, cultural bias in diagnosis (over diagnosis of SZ & under diagnosis of mood disorders)

What is the widely used test to determine the cognitive abilities of individuals?

Standard Clinical Neuropsychological Exam

What is included in the Standard Clinical Neuropsychogical Exam?

premorbid est: single word reading (baseline of where they were before onset, doesnt decline bc of psychosis)

IQ (can decrease overtime, verbal & non verbal components)

sensory exams: hear, touch, visual fields

language: naming, repetition, fluency, comprehension

visual perceptual functions: object/face recognition, drawing

episodic memory (visual/verbal material)

working memory

reasoning & problem solving

attention (graphomotor tests)

executive control: planning

What do neurpsychological tests measure and provide clues to?

cognitive measures represent outputs of integrity of different neutral systems.

1. illness is located in the brain

2. if treatments will impact the right place,

3. useful intermediate phenotypes.

What are the limitations of neuropsychological measures?

sensitivity & specificity

most SC research has used clinical instruments w high sensitivity to impairment but limited specifity.

What are sensitivity & specificity in regards to limitations of neuropsychological tests?

sensitivity: true positive (cognitive test correctly identifies SZ)

specificity: true negative (test correctly identifies ppl without SZ)

Why have NP-measures hung around for so long?

they are easy to use: cheap, brief, standard

they seem to measure different cognitive domains and connect them to real-world functioning

Why is the field hoping to move from NP-measures towards more experimental measures?

to increase precision bc NP measures offer limited neural specificity

What is General Neurocognitive Deficit?

broad profile of impairments across domains, which is visible in SZ (about 1.5 SD below general population).

ranges from complex aspects of cognition (problem solving) to perceptual (olfaction).

not consistent with any models.

What type of disorder was SZ historically thought to be?

fron